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HomeMy WebLinkAbout2015-00975 - water connect , CITY OF ORONO * Z 0 1 5 — 0 0 9 7 5 * 2750 KELLEY PARKWAY DATE ISSUED: 08/03/2015 ORONO, MN 55356- 952 249-4600 FAX: 952 249-4616 ADDRESS : 2460 COBBLESTONE CT PIN : 33-118-23-11-0081 LEGAL DESC : STONEBAY SIXTH ADDITION : LOT 003 BLOCK 001 PERMIT TYPE : WATER PROPERTY TYPE : RESIDENTIAL COI�ISTRUCTION TYPE : CONNECTION NOTE: REPLACING WATER SERVICF_L[NE FOR IRRIGATION APPLICANT WATER CONNECT/DISCONNECT/REPAIR 50.00 STATE SURCHARGE SEWER& WATER 1.00 SCHULTIES PLUMBING TOTAL 51.00 1521 94TH LANE NE BLAINE, MN 55449 Payment(s) (651)786-4007 CHECK 33361 51.00 Minnesota State License#: plbg-058799PM,mech-MB005379 OWIVER Wooddale Builders 6117 BLUE CIRCLE SUITE 101 MINNETONKA, MN 55343- AGREEMENT AND SWORN STATEMENT The work for which this permit is issued shall be performed according to the approved plans and specifications,applicable City approvals,and the Sta[e Building Code. This permit is for only the work described and does not grant permission for additional or related work which requires separate permits. All provisions of laws and ordinances governing this type of work shall be compied with whether or not specified herein.This permit will expire and become null and void if construction authorized is not commenced within 180 days of the date of issuance,or if construction is suspended for a period of 180 days at any time after work has commenced. The applicant is responsible for assuring all required inspections are requested in conformance with the State Building Code.This permit may be revoked at any time for due cause. _-�u� � , � d5 Applicant Permitee Signature Date Issued Signature Date ,,.-�_ ------ - i�'�1RCITl'[�SEOM1Ll' —, �!`j"1��€���1�'; C;ify�f Or'ono Daie Ke�eived: --- Yennit# ------ P '' P.O.Ba�.hF � �� '� 2750 K;IIe��P�rk�ti�}� ❑Gi-House SAC Deterniination I�orm Complated t , ,�� Crvstal Bay,MN 5�i'- �� �'' (952)249-4600/I i�(9i;�_a.i-4b16 Apptuved By(11 Requiredl�. ;�,�,�,:i' ---- CITY OF ORONO—SEL�'ER & WATER/GENEI2�L PERMIT (*Note:Some permits iYiay reyuire approval b�the�3uild;nr Ol`ticial andi�or Puhlic Works Deparitient*) (ALL PI?R�7d"f'S- R1:���be subject to fi�riher revicw�and ma��n�t be issued when the anuiicatiun is received) GENERAI, INFOI�MATION i_ _ � "�__� 1. 1'ou may appiy for utility pennits by mail or in person at the City offices. ?. �iailed in applicatio�is<<re si�bject to the postage and handling fee shown beiow. Permit cards�vi(i be sent by return mail within?busir�ess days. 3. Permits are not valid un�il yqe� receive a perrnit card. 4. Work must not begin unless the�ermii card is available on the job site. 5. Utility connection permits ma��be issued to licensed contractors only. 6. Contact the Public Works Department(452-249-4ti00j for utility stub as-buiit locations. DO NOT EarA�'ATE IN ANY'S'fREET ANI) DO NOT TAP AN1' VIAIN without express approval of the Public Works Deparkment. lssuance of a permit does not grant this approval. 7. All work must be d�ne in ac�ord�i�ce with �tate C'odc requireinents. 3. All�vork m�;st be ins��ected befor�it is covered. �all(952)249-4bCO3 2d+hour r�otice re�uired. -- ---7'YPE Q�=' PERMI"1' .�---`_----------1 ` (Chcck Ai( That ApplY) ✓-----------.�_,—� �Residential(h�1ay Require Approval) ❑Coinmercial(A�piova! Required) ❑ New Connection ❑ Additional Connection ❑Re-Connection ❑ Repairs ❑ Disconnect ❑ V4'ater Availability Connection For Puture Hook-Up to Water Job Site l Owner li�fof•matian: V� � Site ,�ddress: r.�S�foU �:�s�r�t'.�i��� ����` Owner• � /,;�cc.L'��� Mailin�; Address: �/�_9'_/�'� L��"� City: �/�l/!P/J Zip: � � -- Home Phorie: ���3 Alternate Phone: �ontractor Inf�rmation: —� Contt•actor: ;����cy �,�`�, Cc}ntact Persoi�: ,�lJ �� Add::ss: �.� State License #: !�/_��...7����_ f'ity: Zip��S�f Ex�irat�c�r� Date: �—�����-._ Ph��ne: � ��,3'�D��� __ �Ite►•rtate Phor�e: 1������� �-_ � � ______�-7I:'t�}�;IZ,i��tlN1N(► i'i_ftN11"f i;I-�ES _ �_� ❑ SAC Charge(2015 Rate=$2,485.00) $ (SAC Charge inust accompany all sewer permit applications unless prepaid) (Orono City Staff can determine if applicable) (If not prepaid,a sewer connection permit will not be issued) ❑ Sewer Connection/Disconnect/Repair($50.00/Per Stab) � Pipe size__inches;tnaterial Schd 40 air tested; cast iron � Water Conn'gf tion J Disconnec epair($ .00/Per Stub) $ v�� _ Pipe size!%� inches;mater �d 40 air tested:____ copper ❑Water Availability For Fut�ire Hook-Up to 1�ater(�Sa.00) $ '� Water Availabilitv Expianation: Contractor installed line to inside of house for f'uture ho�k-up. This line wi;l be inspected by the Public Works Uepanment. Required Beforc Water Connection Permit is lssued: l. Issue Water Meter&Iiorn Permit 2. Any Additional Connection Fe�s Paid(If Applicable) Issue Water Connection Permit: 1. Collect Pei-mit Fee&Issue Water Connection Permit 1. SIIBTOTAL of Permit Requested: $ ��,bv 2. STATE SURCI-[ARGE $ 1.00 3. POSTAGE& HANDLING(Only on M3il-In Applications) $_ _2.00 �. TOTAL, FFR�117'FEE(�dd Liites 1-3 Aoove) $ c�/,�� � ADDIT!(?NAL INFORMA"TI(?N—WATER METERS _� ■ WATER ME'f'ERS must be picked up and paid far at Orono City 1-�a11,1hese are on a sepc�rate permit. � WATER METERS must be set and sealed by Orono Water Department (952) 249-4600, upon completion of ineter installation. 1'he undersi�;ned hereby applies to the City of Orono for issuance of a Utility Permit, agrees to do all work in strict accordance with the ordinances of the City and the regulations of the State of Minnesota, and certifies that all statements made on this application are,true and correct. Applic __ Date: �� ��!/ — — — �-- �� � 1'`' � ( f �v�/ � � �� � � �r �'. f �, �,��.�i, � �� '�� � ��� � � �*� �tq�. ,}� � +� fy : �. ya' 9 ".' � {� 7h'C'S-�t i .�'; ' 1 F ,>�{G'�.� ' . t w . � . ) �,X„" *» �. ' �a�.� ,, '� y. ; t��ti t� ���� � " '��� y , .� a ,, �. �/ � ��v ck.r;� �"'�' - . :� 4 ::��- /' � �yq r} .r i �,-rr.. � ... � k; .. �, '`��,AM.,.:,��J� � `�` A€, . 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Ca11 for the next inspection 24 hours in advance. (952) 249-4600 OwnerlContractor on site: �h r>� ��S i/�� 4 Inspector. ���— White Copyllnspector's File Canary CopylSite Notice